MRI of a 22-year-old footballer with a locked knee after a twisting injury shows a sagittal image with two parallel low-signal structures in the intercondylar notch resembling a second posterior cruciate ligament. This 'double PCL sign' indicates:
- A Bucket-handle tear of the medial meniscus ✓
- B Complete rupture of the anterior cruciate ligament
- C Discoid lateral meniscus
- D Meniscal ossicle
Correct answer: A. Bucket-handle tear of the medial meniscus
Explanation
In a bucket-handle meniscal tear, the flipped inner fragment of the meniscus lies anterior to and parallel with the PCL in the intercondylar notch, producing the double PCL sign on sagittal MRI. It is characteristic of a large vertical longitudinal tear, most often of the medial meniscus, and correlates clinically with locking. ACL rupture appears as fibre discontinuity or absence, not as a second ligament-like structure.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.